Infectious endocarditis without intracardiac devices or underlying structural heart disease.

OBJECTIVE: To describe clinical, microbiological and echocardiographic aspects of endocarditis in a specific group of patients without intracardiac devices or underlying structural heart disease. METHOD: Retrospective study, clinical records and echocardiographic reports were reviewed during the period 1997 to 2020. Duke's modified criteria were applied. Statistical analysis: univariate expressed in frequencies, using measures of dispersion and central tendency. RESULTS: 30,000 echocardiographic reports were reviewed, only 1350 had infectious endocarditis as a reason for sending, of which 248 cases were selected. The mean age was 48.1 ± 16.7 years. 140 men (56%) and 108 women (44%). The most frequent echocardiographic sign was vegetation, in 278 (93.60%), and most common location was mitral (35.55%), with a higher number of cases in the right ventricle than expected. The most common systemic disease was kidney disease, in 135 (41.08%). A case of Streptococcus thoraltensis not previously reported in Mexico was identified. CONCLUSIONS: The presence of infectious endocarditis has increased due to invasive in-hospital and drug procedures. Due to their complexity, multidisciplinary teams are indispensable.

OBJETIVO: Describir aspectos clínicos, microbiológicos y ecocardiográficos de endocarditis en un grupo específico de pacientes sin dispositivos intracardiacos ni cardiopatía estructural subyacente. MÉTODO: Estudio retrospectivo en el que se revisaron expedientes clínicos y reportes ecocardiográficos durante el periodo de 1997 a 2020. Se aplicaron los criterios modificados de Duke. Se describió la muestra por edad, sexo, enfermedad sistémica, vegetaciones y agente microbiológico. Se excluyeron pacientes con cardiopatía estructural o Libman-Sacks. Análisis estadístico: univariado expresado en frecuencias, utilizando medidas de dispersión y tendencia central. RESULTADOS: Se revisaron 30,000 reportes ecocardiográficos, de los cuales solo 1350 tenían como motivo de envío endocarditis infecciosa, y de estos se seleccionaron 248 casos. La edad promedio fue de 48.1 ± 16.7 años. Hubo 140 hombres (56%) y 108 mujeres (44%). El signo ecocardiográfico más frecuente fue la vegetación, en 278 (93.60%), y la ubicación más común fue mitral (35.55%), con un número mayor de casos en el ventrículo derecho de lo esperado. La enfermedad sistémica más común fue la enfermedad renal, en 135 (41.08%). Se identificó un caso de Streptococcus thoraltensis no reportado previamente en México. CONCLUSIONES: La presencia de endocarditis infecciosa ha aumentado debido a procedimientos invasivos intrahospitalarios y fármacos. Por su complejidad, los equipos multidisciplinarios son indispensables.

A Geospatial Model to Identify Areas Associated with Late- Stage Breast Cancer: A Spatial Epidemiology Approach.

OBJECTIVE: The aim of this study was to show how a geospatial model can be used to identify areas with a higher probability for late-stage breast cancer (BC) diagnoses. METHODS: Our study considered an ecological design. Clinical records at a tertiary care hospital were reviewed in order to obtain the place of residence and stage of the disease, which was classified as early (0-IIA) and late (IIB-IV) and whose diagnoses were made during the 2013-2017 period. Then, they were geolocated to identify the distribution and spatial trend. Subsequently, the pattern of location, i.e. scattered, random and concentrated, was statistically assessed and a geospatial model was elaborated to determine the probability of late diagnoses in the state of Jalisco, Mexico. RESULT: There were 1 954 (N) geolocated BC diagnoses: 58.3% were late. During the five-year period, a southwest-northeast trend was identified, nearly 9.5% of the surface of Jalisco, where 6 out of 10 (n= 751) late- stage diagnoses were concentrated. A concentrated and statistically significant pattern was identified in the southern, central and northern Pacific area of Jalisco, where the geospatial model delimited the places with the highest probability of late clinical stages (p <0.05). CONCLUSION: The geographical differences associated with the late diagnoses of BC suggest it is necessary to adapt and focus the strategies for early detection as an alternative to create a major impact on the population. Reproducible analysis tools were used in other contexts where geolocation data are available to complement public policies and strategies aimed to control BC.

Towards medicine of excellence in Mexico: the "Código Infarto" protocol, a view from the perspective of translational bioethics.

INTRODUCTION: Mexico is the country with the highest mortality due to ST-elevation acute myocardial infarction (STEMI), and the IMSS has therefore developed the protocol of care for emergency departments called Código Infarto (Infarction Code). In this article, aspects of translational medicine are discussed with a bioethical and comprehensive perspective. OBJECTIVE: To analyze the Código Infarto protocol from the perspective of translational bioethics. METHOD: A problem-centered approach was carried out through reflective equilibrium (or Rawls' method), as well as by applying the integral method for ethical discernment. RESULTS: The protocol of care for emergency services Código Infarto is governed by evidence-based medicine and value-based medicine; it is guided by a principle of integrity that considers six dimensions of quality for the care of patients with STEMI. CONCLUSION: The protocol overcomes some adverse social determinants that affect STEMI medical care, reduces mortality and global economic disease burden, and develops medicine of excellence with high social reach.

INTRODUCCIÓN: México es el país con mayor mortalidad por infarto agudo de miocardio con elevación del segmento ST (IAM CEST), por lo que el Instituto Mexicano del Seguro Social desarrolló el protocolo de atención para los servicios de urgencias denominado Código Infarto. En este artículo se discuten aspectos de la medicina traslacional con una perspectiva bioética e integral. OBJETIVO: Analizar el protocolo Código Infarto desde la perspectiva de la bioética traslacional. MÉTODO: Se realizó una aproximación centrada en el problema a través del equilibrio reflexivo, así como la aplicación del método integral para el discernimiento ético. RESULTADOS: El protocolo de atención para los servicios de urgencias Código Infarto se rige por la medicina basada en la evidencia y la medicina basada en valores; se orienta por el principio de integridad que considera las seis dimensiones de la calidad para la atención de pacientes con IAM CEST. CONCLUSIÓN: El protocolo supera algunos determinantes sociales adversos que afectan la atención médica del IAM CEST, disminuye la mortalidad, la carga económica global de la enfermedad y desarrolla una medicina de excelencia de alto alcance social.

Hacia una medicina de excelencia en México: el protocolo Código Infarto, una visión desde la bioética traslacional / Towards medicine of excellence in Mexico: the "Código Infarto" protocol, a view from the perspective of translational bioethics

Resumen Introducción: México es el país con mayor mortalidad por infarto agudo de miocardio con elevación del segmento ST (IAM CEST), por lo que el Instituto Mexicano del Seguro Social desarrolló el protocolo de atención para los servicios de urgencias denominado Código Infarto. En este artículo se discuten aspectos de la medicina traslacional con una perspectiva bioética e integral. Objetivo: Analizar el protocolo Código Infarto desde la perspectiva de la bioética traslacional. Método: Se realizó una aproximación centrada en el problema a través del equilibrio reflexivo, así como la aplicación del método integral para el discernimiento ético. Resultados: El protocolo de atención para los servicios de urgencias Código Infarto se rige por la medicina basada en la evidencia y la medicina basada en valores; se orienta por el principio de integridad que considera las seis dimensiones de la calidad para la atención de pacientes con IAM CEST. Conclusión: El protocolo supera algunos determinantes sociales adversos que afectan la atención médica del IAM CEST, disminuye la mortalidad, la carga económica global de la enfermedad y desarrolla una medicina de excelencia de alto alcance social.

Abstract Introduction: Mexico is the country with the highest mortality due to ST-elevation acute myocardial infarction (STEMI), and the IMSS has therefore developed the protocol of care for emergency departments called Código Infarto (Infarction Code). In this article, aspects of translational medicine are discussed with a bioethical and comprehensive perspective. Objective: To analyze the Código Infarto protocol from the perspective of translational bioethics. Method: A problem-centered approach was carried out through reflective equilibrium (or Rawls' method), as well as by applying the integral method for ethical discernment. Results: The protocol of care for emergency services Código Infarto is governed by evidence-based medicine and value-based medicine; it is guided by a principle of integrity that considers six dimensions of quality for the care of patients with STEMI. Conclusion: The protocol overcomes some adverse social determinants that affect STEMI medical care, reduces mortality and global economic disease burden, and develops medicine of excellence with high social reach.

Central blood pressure and vascular stiffness in Mexican population / Presión central aórtica y rigidez vascular en mexicanos

Abstract Introduction: Central blood pressure (CBP) is considered a measure of prognostic value for cardiovascular risk. In turn, the aortic pulse wave velocity (PWVAo) and augmentation index (Aix) have been related to arterial stiffness and cardiovascular risk. Controversies exist regarding the reference values in different ethnic groups, ages, and anthropometrics. The objective of this study is to evaluate the CBP and arterial stiffness parameters in a Mexican population by age, gender, and anthropometry. Methods: Between 2015 and 2016, 1009 apparently healthy subjects were recruited in the Instituto Nacional de Cardiología Ignacio Chávez. Using the Arteriograph (TensioMed) equipment with an oscillometric technique, CBP, central pulse pressure (cPP), PWVAo, and Aix were acquired. All results were automatically obtained by computer software version 3.0.0.4. Results: Female sex was prevalent (72%), mean age was 47 ± 12 years; 26% had normal weight, 43% were overweight, and 30% had obesity. The reference values were higher than those reported in other populations. PWVAo and Aix were always found to be higher in females. A central-brachial pressure gradient was observed in < 40 years with lower CBP. Body mass index (BMI) presented a direct and positive correlation with CBP (p < 0.001); however, PWVAo and Aix were not modified. Conclusion: CBP, cPP, PWVAo, and Aix parameters should be considered based on age, gender, and BMI. In Mexican population, CBP and cPP values were higher compared with other previously reported values, especially in women, the elderly, and obese. PWVAo and Aix are higher in older women; however, they are not modified by BMI.

Resumen Introducción: La presión central aórtica (PCA) se considera una medida del valor pronóstico. A su vez, la velocidad de la onda del pulso aórtico (VOPA) y el índice de aumento (IA) se han relacionado con la rigidez arterial y riesgo cardiovascular. Existen controversias sobre los valores de referencia en diferentes grupos. El objetivo de este estudio es evaluar estos parámetros en una población mexicana por edad, género y antropometría. Métodos: Entre 2015 y 2016 se reclutaron 1,009 sujetos aparentemente sanos en el Instituto Nacional de Cardiología Ignacio Chávez. Usando el equipo de Arteriograph (TensioMed) con técnica oscilométrica, se adquirieron: PCA, presión de pulso central, VOPA e IA. Todos los resultados fueron obtenidos automáticamente. Resultados: El sexo femenino fue prevalente (72%), edad de 47 ± 12 años; 26% con peso normal, 43% con sobrepeso y 30% con obesidad. Todos los valores fueron superiores a los reportados en otras poblaciones. VOPA e IA siempre fueron más altos en mujeres. Se observó un gradiente de presión central-braquial en < 40 años, con menor PCA. El IMC presentó una correlación directa y positiva con la PCA (p < 0,001), sin embargo, VOPA e IA no se modificaron. Conclusión: Los parámetros de PCA, VOPA e IA deben considerarse en función de edad, género e IMC. En una población mexicana, los valores de PCA fueron más altos en comparación con informados previamente (Europa y Asia), especialmente en mujeres, ancianos y obesos. VOPA e IA son más altos en mujeres mayores; sin embargo, no son modificados por el IMC.

Central blood pressure and vascular stiffness in Mexican population.

Introduction: Central blood pressure (CBP) is considered a measure of prognostic value for cardiovascular risk. In turn, the aortic pulse wave velocity (PWVAo) and augmentation index (Aix) have been related to arterial stiffness and cardiovascular risk. Controversies exist regarding the reference values in different ethnic groups, ages, and anthropometrics. The objective of this study is to evaluate the CBP and arterial stiffness parameters in a Mexican population by age, gender, and anthropometry. Methods: Between 2015 and 2016, 1009 apparently healthy subjects were recruited in the Instituto Nacional de Cardiología Ignacio Chávez. Using the Arteriograph (TensioMed) equipment with an oscillometric technique, CBP, central pulse pressure (cPP), PWVAo, and Aix were acquired. All results were automatically obtained by computer software version 3.0.0.4. Results: Female sex was prevalent (72%), mean age was 47 ± 12 years; 26% had normal weight, 43% were overweight, and 30% had obesity. The reference values were higher than those reported in other populations. PWVAo and Aix were always found to be higher in females. A central-brachial pressure gradient was observed in < 40 years with lower CBP. Body mass index (BMI) presented a direct and positive correlation with CBP (p < 0.001); however, PWVAo and Aix were not modified. Conclusion: CBP, cPP, PWVAo, and Aix parameters should be considered based on age, gender, and BMI. In Mexican population, CBP and cPP values were higher compared with other previously reported values, especially in women, the elderly, and obese. PWVAo and Aix are higher in older women; however, they are not modified by BMI.

Introducción: La presión central aórtica (PCA) se considera una medida del valor pronóstico. A su vez, la velocidad de la onda del pulso aórtico (VOPA) y el índice de aumento (IA) se han relacionado con la rigidez arterial y riesgo cardiovascular. Existen controversias sobre los valores de referencia en diferentes grupos. El objetivo de este estudio es evaluar estos parámetros en una población mexicana por edad, género y antropometría. Métodos: Entre 2015 y 2016 se reclutaron 1,009 sujetos aparentemente sanos en el Instituto Nacional de Cardiología Ignacio Chávez. Usando el equipo de Arteriograph (TensioMed) con técnica oscilométrica, se adquirieron: PCA, presión de pulso central, VOPA e IA. Todos los resultados fueron obtenidos automáticamente. Resultados: El sexo femenino fue prevalente (72%), edad de 47 ± 12 años; 26% con peso normal, 43% con sobrepeso y 30% con obesidad. Todos los valores fueron superiores a los reportados en otras poblaciones. VOPA e IA siempre fueron más altos en mujeres. Se observó un gradiente de presión central-braquial en < 40 años, con menor PCA. El IMC presentó una correlación directa y positiva con la PCA (p < 0,001), sin embargo, VOPA e IA no se modificaron. Conclusión: Los parámetros de PCA, VOPA e IA deben considerarse en función de edad, género e IMC. En una población mexicana, los valores de PCA fueron más altos en comparación con informados previamente (Europa y Asia), especialmente en mujeres, ancianos y obesos. VOPA e IA son más altos en mujeres mayores; sin embargo, no son modificados por el IMC.

STEMI and NSTEMI: Real-world Study in Mexico (RENASCA).

INTRODUCTION: Mexico is the country with the highest mortality due to acute myocardial infarction in adults older than 45 years old according to the OECD (28 vs. 7.5% of the average). The first real-world study, RENASCA IMSS, showed a high-risk population at 65%, but 50% without reperfusion strategies. The aim was to describe the clinical presentation, treatment, and outcomes of acute coronary syndromes at the IMSS. METHODS: RENASCA IMSS is a nation-wide, prospective, longitudinal-cohort study. We include consecutive patients with an Acute Coronary Syndrome diagnosis (ACC/AHA/ESC) admitted in 177 representative hospitals of the IMSS (166 of second level and 11 of third level of attention). In an electronic database clinical, paraclinical, times, reperfusion treatment, complications, and other variables were assessed. Confidentiality was maintained in data and informed consent was obtained. Registrer calibration was performed with more than 80% of the variables and 80% of the cases. RESULTS: From March 1, 2014 to December 25, 2017; 21,827 patients were enrolled presenting an average age 63.2 ± 11.7, 75% men (16,259) and 25% women (5,568). The most frequent risk factors were: hypertension (60.5%), smoking (46.8%), diabetes (45.5%), dyslipidemia (35.3%) and metabolic syndrome (39.1%). STEMI diagnosis was established in 73.2% of the patients and NSTEMI in 26.8%. The STEMI group within the Code Infarction showed an improvement in the reperfusion therapy (34.9% before vs. 71.4% after, p ≤0.0001) and reduction of mortality (21.1 vs. 9.4%, p ≤0.0001); while the NSTEMI group showed high risk set by a GRACE score of 131.5 ± 43.7 vs. 135.9 + 41.7, p ≤0.0001. Mortality was more frequent within the STEMI group (14.9 vs. 7.6%, p ≤0.0001). CONCLUSIONS: RENASCA IMSS study represents the largest Acute Coronary Syndromes real-world study in Mexico, demonstrating that the Mexican population has a high risk. Patients with a STEMI diagnosis were more frequently enrolled and were associated with higher mortality and complications; however, there is improvement in the reperfusion therapy and in mortality with the Code Infarction strategy.

Acute toxicity, antinociceptive activity and indole alkaloids of aqueous extract from bark of Aspidosperma cuspa (Kunth) Blake.

UNLABELLED: ETNOPHARMACOLOGICAL RELEVANCE: Aspidosperma cuspa (Kunth) Blake (Apocynaceae) is popularly known as "amargosa" or "cuspa", and its bark is used in folk medicine primarily for pain. AIM OF THE STUDY: In the present study the acute toxicity, antinociceptive effect and alkaloids of the aqueous decoction extract of the Aspidosperma cuspa bark in mice was investigated. MATERIALS AND METHODS: Acute toxicity was tested using a variation of the method described by Lichfield and Wilcoxon. The antinociceptive activity was evaluated using the acetic acid induced writhing and tail-flick tests. The phytochemical analysis was performed. RESULTS AND CONCLUSION: Oral administration of the extract did not cause animal death (LD(50)>4 g/kg), and the histological analysis showed an absence of alterations in all organs examined. TD(50) of the extract was 0.5521 g/kg for male mice and 1.1565 g/kg for females. The aqueous extract at doses 276 mg/kg (p.o.) did not produce a significant inhibition of acetic acid-induced writhes, but showed a significant effect in tail-flick test. Naloxone, an opioid receptor antagonist, pretreatment inhibited significantly the antinociceptive activity of the extract. It is suggested that the aqueous decoction extract of the bark of Aspidosperma cuspa has an antinociceptive effect, and this may be mediated by opioid receptors. Three indole alkaloids (aspidocarpine, 11-methoxytubotaiwine and picraline) were isolated from the aqueous extract. The antinociceptive activity of the extract is presumed to be due to these compounds.

Presencia de organismo asociados a helicobacter (HLO) después de 21 días de tratamiento en perros asintomáticos: un estudio preliminar / Presence of helicobacter like organisms after twenty one days of treatment in asympotomatic dogs: a preliminar study

La presencia de Organismos Asociados a Helicobacter (HLO), en el estomago de perros y gatos ha sido descrito previamente. El objetivo de este estudio fue evaluar la presencia de Organismos Asociados a Helicobacter, después de 21 días de tratamiento en perros asintomáticos. Siete perros fueron tratados durante 21 días con doxiciclina comercial en dosis 20mg/kg/día. Muestras de estomago fueron colectadas por gastroendoscopia. Secciones de tejido gástrico fueron procesadas, coloreadas con Hematoxilina y Eosina (H&E) y observadas en el microscopio óptico. Ninguno de los perros presento signos clínicos previos de enfermedad gastrointestinal. En el examen gastroendoscopico previo al tratamiento fue observada una mucosa gástrica normal en 1/7 perros, gastritis aguda superficial 3/7, gastritis crónica superficial 1/7, gastritis crónica atrófica 1/7 y gastritis erosiva ulcerosa 1/7. El estudio histopatológico revelo gastritis aguda superficial, erosión focal e hiperqueratosis con infiltración de linfocitos en la lamina propia. La presencia de bacterias tipo espiroquetas en el moco gástrico y en las glándulas fúndicas fue observada y asociada con lesiones gástricas. La evaluación gastroendoscopica después del tratamiento con doxiciclina revelo: 4/7 perros con mucosa gástrica normal, 2/7 con gastritis aguda superficial y 1/7 con gastritis crónica superficial. Los cortes histológicos de mucosa gástrica evidenciaron gastritis aguda superficial, erosión focal e hiperqueratosis focal infiltrado por linfocitos en la lámina propia. Ninguna muestra mostró bacterias tipo espiroquetas después del tratamiento con doxiciclina.Estos resultados nos permiten concluir que el tratamiento con doxiciclina es efectivo sobre la presencia de Organismos Asociados a Helicobacter en la mucosa gástrica de caninos

The presence of gastric Helicobacter-like organisms (HLO) in the stomach of dogs and cats has been known for many years, but the relationship between those organisms and gastric disease remains controversial. The objective of this study was to evaluate the presence of Helicobacter like organisms after twenty one days of treatment in asymptomatic dogs. Seven dogs were treated for 21 days with commercial doxycycline at a dose of 20mg/kg/day. Stomach samples were collected by gastroendoscopy from 7 dogs, before an after doxycycline treatment. Gastric tissue sections were prepared and stained with Hematoxilin & Eosin (H&E) for light microscopy. None of these dogs showed previous clinical signs of gastrointestinal disease. In the gastroendoscopy study after of doxycycline treatment we found a normal gastric mucosa in 1/7 dogs, acute superficial gastritis in 3/7, chronic superficial gastritis in 1/7, chronic atrophic gastritis 1/7 and chronic ulcer-erosive gastritis in 1/7. The histopathological study showed acute surface gastritis, focal erosion and hyperkeratosis with lymphocytes infiltration in the lamina propria. The presence of spirochetal shaped bacterias in the gastric mucus and fundus mucousglands were observed associated with gastric lesions. Gastroendoscopy after treatment with doxycycline reveled: 4/7 gastric mucosa normal, 2/7 superficial acute gastritis and 1/7 superficial chronic gastritis. Histopathology showed acute gastritis surface, erosion focal and hyperkeratosis focal infiltrated of lymphocytes in the lamina propria. None samples showed spiral shape bacterial after the treatment with doxyclyne. We conclude that doxycycline is effective for HLO on presence in gastric mucosa of dogs

Muerte súbita asociada a hipersensibilidad tipo I en un equino pura sangre de carrera / Sudden death associated to type I hypersensitivity in a racing horse

El objetivo de este estudio fue reportar un caso de hipersensibilidad tipo I con muerte súbita en un equino Pura Sangre de Carrera en el Hipódromo “La Rinconada” Caracas, Venezuela. Se tomaron muestras de sangre y orina para estudios toxicológicos mediante la técnica de ELISA competitivo. Se le práctico la técnica de necropsia, fueron colectadas muestras de musculo, tejido pulmonar, hepático, renal, gástrico, esplénico, corazón y sistema nervioso central para estudio histopatológico, las muestras fueron procesados por los métodos convencionales histológicos. Los hallazgos de necropsia fueron flebitis severa en vena yugular derecha, con hematoma en el surco yugular. Edema severo de glotis, edema, congestión y hemorragia pulmonar. Hemorragia petequial subendocardica. Bazo esplenocontraido y con focos de necrosis de coagulación. Hidronefrosis aguda con hematuria. Hígado con patrón lobulillar acentuado. El resto de los órganos con evidente congestión y hemorragia. Los cortes histológicos evidenciaron edema, congestión y hemorragia pulmonar severa. Hemorragia subepicardica marcada. Edema subcapsular esplénico y necrosis centro-folicular. Degeneración hidropica tubular, necrosis tubular aguda. Necrosis de corteza renal. Los estudios toxicológicos permitieron la detección de furosemida y fenilbutazona en las muestras de sangre y orina. En conclusión se reporta un síndrome de hipersensibilidad tipo I asociado a la administración de un producto comercial a base de Vitamina E 80mg, Pangamato sódico (B15) 1 mg, Selenio Sódico 0.6 mg, Antioxidantes y Vehículos Solubles c.s.p. con colapso, shock y muerte aguda en un equino Pura Sangre de Carrera mediante un estudio multidisciplinario clínico, anatomopatologico y toxicológico.

The aim of this study was to report a case of type I hypersensitivity to sudden death in a Thoroughbred race horses at the Hippodrome “La Rinconada” Caracas, Venezuela. Samples of blood and urine for toxicology studies using competitive ELISA. He practiced the technique of necropsy, samples were collected from muscle, lung tissue, liver, kidney, stomach, spleen, heart and central nervous system for histopathological examination, samples were processed by conventional histological methods. Autopsy findings were severe phlebitis right jugular vein, with hematoma in the jugular groove. Severe edema of glottis edema, pulmonary congestion and hemorrhage. Subendocardial petechial hemorrhage. Esplenocontraido Spleen foci of necrosis and coagulation. Hydronephrosis with acute hematuria. Liver accentuated lobular pattern. The rest of the organs with obvious congestion and hemorrhage. The histological sections showed edema, severe pulmonary congestion and hemorrhage. Marked subepicardial hemorrhage. Edema and necrosis subcapsular splenic follicular center. Tubular hydropic degeneration, acute tubular necrosis. Necrosis of renal cortex. Toxicological studies allowed the detection of furosemide and phenylbutazone in samples of blood and urine. In conclusion we report type I hypersensitivity syndrome associated with the administration of a commercial product based Vitamin E 80mg, sodium pangamate (B15) 1 mg, 0.6 mg; Sodium Selenium, Soluble Antioxidants and Vehicle qs with collapse, shock and acute death in a race Thoroughbred horses by a multidisciplinary clinical, pathological and toxicological.

Frecuencia y causa de mortalidad en caballos de pura sangre inglés de carreras en el Hipodromo “La Rinconada” Caracas, Venezuela / Frequency and causes of death in thoroughbred horses in the racetrack “La Rinconada” Caracas, Venezuela

Este trabajo describe la frecuencia y causas de muerte súbita o que conllevaron a la eutanasia de caballos de carreras Pura Sangre Inglés del Hipódromo “La Rinconada” en Caracas, Venezuela. Se estudiaron 129 casos de mortalidad, 69 en caballos y 60 en yeguas, de una población de 1900 equinos durante el año 2009, mediante necropsia y análisis hematológicos, bacteriológicos e histopatológicos. La mortalidad anual fue por lo tanto 7% con un promedio mensual de 11 equinos muertos. La frecuencia de causas de mortalidad fue 40% (51/129) por historial de fracturas, 39% (50/129) por historia de crisis abdominal aguda, 13% (17/129) por enfermedades infecciosas, 5% (6/129) por reacciones de hipersensibilidad asociadas a la administración de fármacos y 4% (5/129) por hemorragia pulmonar inducida por el ejercicio. Las fracturas se presentaron en mayor frecuencia en el miembro anterior izquierdo (40%), seguido del miembro anterior derecho (29%), miembro posterior izquierdo (4%) y miembro posterior derecho (4%) y un 23% de los équidos sufrieron fracturas de la cabeza. Entre los animales que murieron por causas bacterianas se realizaron un total de 17 aislamientos bacterianos que incluyeron a las especies Escherichia coli (12/17), Proteus mirabilis (2/17), Klebsiella (1/17), Pseudomonas aeruginosa (1/17) y Streptococcus equi subespecie zooepidemicus (1/17)(AU)

The objective of this study was to describe the frequency and causes of sudden death or euthanasia of racing Thoroughbred horses from the Racetrack “La Rinconada” in Caracas, Venezuela in the year 2009. Cases were investigated by performing haematological and biochemical blood tests, necropsy and bacteriological and histopathological analysis. The number of cases was 129 cases including 69 horses and 60 mares, which represented a 7% (129/1900) fatality rate with an average of 11 fatalities per month. Among the causes of death, 40% (51/129) were the result of limb fractures, 39% (50/129) from acute abdominal crisis, 13% (17/129) associated to infections, 5% (6/129) from hypersensitivity reactions following the administration of pharmaceuticals and 4% (5/129) from exercise-induced lung hemorrhage. Limb fractures occurred more frequently in the left forelimb (40%), followed by the right forelimb (29%), left hind limb (4%) and right hind limb (4%) and 23% of fractures occurred affected the skull. Bacteria isolated from the 17 infectious case fatalities included Escherichia coli (12/17), Proteus mirabilis (2/17), Klebsiella (1/17), Pseudomonas aeruginosa (1/17) and Streptococcus equi subspecies zooepidemicus (1/17)(AU)

Hipersensibilidad tipo I asociada a la administración de nandrolona, boldenona y dexametasona en un equino pura sangre de carrera / Hypersensitivity type i associated with the administration of nandrolone, boldenone and dexamethasone on a thoroughbred race horse

El doping consiste en la administración ilícita de fármacos o de otros agentes en animales de competición con la intención de alterar su rendimiento físico, ya sea en sentido positivo o negativo. El objetivo de este estudio fue reportar un caso de hipersensibilidad tipo I asociado a administración ilícita de nandrolona, boldenona y dexametasona. Se remite un equino (Pura Sangre de Carrera), de 5 años, con historia de colapso y muerte súbita post administración de fármaco desconocido. Se tomaron muestras de sangre y orina para estudios toxicológicos mediante la técnica de ELISA competitivo. Se le práctico la técnica de necropsia, fueron colectadas muestras de tejido pulmonar, hepático, renal, gástrico, esplénico, corazón y sistema nervioso central para estudio histopatológico, las muestras fueron procesados por los métodos convencionales histológicos. Los hallazgos de necropsia fueron flebitis severa en vena yugular derecha, con hematoma en el surco yugular. Edema severo de glotis, edema, congestión y hemorragia pulmonar. Hemorragia petequial subendocardica. Bazo esplenocontraido y con focos de necrosis de coagulación. Hidronefrosis aguda con hematuria. Hígado con patrón lobulillar acentuado. El resto de los órganos con evidente congestión y hemorragia. Los cortes histológicos evidenciaron edema, congestión y hemorragia pulmonar severa. Hemorragia subepicardica marcada. Edema subcapsular esplénico y necrosis centro-folicular. Degeneración hidropica tubular, necrosis tubular aguda. Necrosis de corteza renal. Los estudios toxicológicos permitieron la detección de boldenona, nandrolona y dexametasona genérica en las muestras de sangre y orina. En conclusión se reporta un síndrome de hipersensibilidad tipo I asociado a la administración nandrolona, boldenona y dexametasona

The doping is the administration of illicit drugs or other agents in animal competition with the intention of altering its physical performance, whether positive or negative. The aim of this study was to report a case of type I hypersensitivity associated with illicit administration of nandrolone, boldenone and dexamethasone. Reference is an equine (Thoroughbreds), 5 years old with a history of collapse and sudden death after the administration of medication unknown. Samples of blood and urine were recollected for toxicological by competitive ELISA. Tissue samples were collected by necropsy of lung, liver, kidney, stomach, spleen, heart and central nervous system for histopathological study, the samples were processed by conventional histological methods. The necropsy findings were severe phlebitis right jugular vein, with hematoma in the jugular furrow. Severe edema of glottis, pulmonary congestion and hemorrhage. Subendocardial petechial hemorrhage. Spleen foci of coagulation necrosis. Acute hydronephrosis and hematury. Liver with accentuated lobular pattern. The rest of the bodies with obvious congestion and hemorrhage. The histological sections showed edema, congestion and severe pulmonary hemorrhage. Marked subepicardial hemorrhage. Edema and necrosis of splenic subcapsular follicular center. Tubular hydropic degeneration, acute tubular necrosis. Necrosis of renal cortex. Toxicological studies allowed the detection of boldenone, nandrolone and dexamethasone generic in blood and urine samples. In conclusion we report a type I hypersensitivity syndrome associated with the administration nandrolone, boldenone and dexamethasone

Iatrogenic equine metabolic syndrome in thoroughbred horses

Equine metabolic syndrome (EMS) is a cluster of problem that includes obesity, insulin resistance and laminitis. In EMS peripheral adipocytes synthesize adipokines which are analogous to cortisol, resulting in Cushing syndrome like-signs and insulin resistance. The used of dexamethasone and triancinolone is very common and not permitted. Hypothesis or Objectives: The objective of this study was to describe metabolic syndrome iatrogenic in Thoroughbred horses. Were studied 22 Thoroughbred horses (12 female and 10 male), between 2-5 years old, in the national race Track “La Rinconada” Caracas-Venezuela. All equine were euthanized and study by necropsy. Samples were collected from the adrenal glands, gastric mucosa, pancreas, kidneys, liver, spleen, lungs, heart and adenohypofisys. Tissue sections were prepared and stained with Hematoxilin & Eosin (H&E) for light microscopy. Results: Clinical signs were polyury, polydipsy and secondary diabetes mellitus, recurrent infection, lethargie, laminitis and weight loss syndrome. Were isolates of recurrent infection: Salmonella sp., E. coli, Streptococcus sp, Staphylococcus, Enterococcus faecalis and Enterobacter cloacae. Necropsy revealed: weight loss, loss fatty subcutaneous, xantomathosis of subcutaneous tissue. Abscess in coxal tuberous, facial and shoulder region. Liver was swollen, friable and icteric. Renal cortical and papillary necrosis. Equine gastric ulcer syndrome severed. Liver with periacinar necrosis with a prominent acinar pattern and fatty degeneration severed. Necrosis and vacuolar (glycogen) degeneration islets of langerhans, fibrosis and chronic. Renal cortical and medullary necrosis, acute tubular necrosis and glycogen nephrosis, glomerulonephritis membranous. Hemorrhages in adrenal cortex and atrophy cortical. Conclusions: These results suggest a iatrogenic EMS in Thoroughbred associated with overdose and chronic dexamethasone and triancinolona

Transportacao ossea com fixador externo RALCA (Alvarez Cambras): apresentacao de un caso / Bone tranfer with the RALCA (Alvarez Cambras) external fixator: a caso report

Se presenta un paciente con una seudoartrosis septica y un defecto oseo de 13 cm, al cual se le realizó una transportación osea utilizando el fijador externo cubano del profesor Alvarez Cambras. El resultado obtenido fue satisfactorio

Uso del epiplón autólogo en el tratamiento de fracturas abiertas de tibia / Use of autologue omentum in the management of open tibial fractures

Se realizó el tratamiento de fracturas abiertas de la tibia, combinadas con pérdida de piel y partes blandas, a las cuales se les aplicó en cuatro ocasiones injerto de epiplón libre homólogo. Se destacan los buenos resultados obtenidos

Uso del epiplón autólogo no tratamento das fracturas abertas da tibia / Use of autologue omentum in the management of open tibial fractures

Se realizó el tratamiento de fracturas abiertas de la tibia, combinadas con pérdida de piel y partes blandas, a las cuales se les aplicó en cuatro ocasiones injerto de epiplón libre homólogo. Se destacan los buenos resultados obtenidos

Transportacao ossea com fixador externo RALCA (Alvarez Cambras): apresentacao de un caso / Bone tranfer with the RALCA (Alvarez Cambras) external fixator: a caso report

Se presenta un paciente con una seudoartrosis septica y un defecto oseo de 13 cm, al cual se le realizó una transportación osea utilizando el fijador externo cubano del profesor Alvarez Cambras. El resultado obtenido fue satisfactorio